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Organ Transplantation

Organ transplantation from donors infected by Naegleria fowleri has occurred on at least five occasions in the U.S. and none of the organ recipients became infected 1,2,3. However, although transmission via organ transplantation has not been documented for Naegleria fowleri, three clusters of transplant associated Balamuthia mandrillaris infection, another type of free-living ameba, have been reported to CDC 4,5. In addition, there are limited data from animal studies 6–9 and historical case reports 10-14 suggesting that hematogenous spread of Naegleria amebae to extra-CNS organs might be possible, particularly late in the clinical course of PAM when tissue destruction is greatest and the blood-brain barrier is compromised. Further, the CDC Free-Living Ameba Laboratory has recently observed Naegleria fowleri in tissue sections of lung, kidney, heart, spleen, and thyroid from two deceased PAM cases, although tissue cross-contamination during autopsy cannot be ruled out 15. As a result, although the risk of transmission of Naegleria fowleri by donor organs is still unknown, it is unlikely to be zero so the risks of transplantation with an organ possibly harboring Naegleria fowleri should be carefully weighed for each individual organ recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. This warrants continued study of the benefits and risks of transplanting organs or tissues from people infected by Naegleria fowleri15.